Robin Cook - Foreign Body

What had been quickly recognized was that real data were needed involving private Indian hospitals, particularly in relation to outcomes, mortality, and complications, which included such statistics as infection rates. Yet the data were not available. The group had checked the Internet, medical journals, and even the Indian health ministry, which they soon discovered was dead set against releasing any such information, even refusing to admit if it existed. In their own ads they used no data whatsoever, merely claiming their outcomes were as good as or better than outcomes in the West.

Stymied for a time, the group had suddenly realized they needed a fifth column inside the private Indian hospitals participating in the highly profitable and growing medical tourism industry. What would have been best were accountants, but the efficacy of that idea seemed questionable at best. Instead, they had hit on the idea of using nurses, mainly because Santana knew something the others didn’t — namely, that there existed a worldwide business in nurses. In the West there was a shortage. In the East, particularly in the Philippines and India, there was a surplus, with many young nurses desperately wanting to emigrate to the United States for economic and cultural reasons but facing significant, almost insurmountable, hurdles.

After extensive research and much discussion, Cal et al. had decided to go into the nurse business by founding a company called Nurses International. Their plan, as was accomplished, was to hire a dozen young and vulnerable, attractive, impressionable, newly graduated Indian nurses, pay them U.S. nurses’ wages, and bring them to the States on tourist visas, specifically to California, for a monthlong training session with the idea of turning them into a team of beholden and therefore easily manipulated spies. In California they had been purposefully spoiled to maximize their manipulability and to take advantage of their wish to emigrate. At the same time, they had been trained in computers during the morning hours, particularly in regard to computer-hacking techniques. In the afternoons they had worked for a few hours as nurses in a SuperiorCare hospital to improve their American English as well as acquaint them with American patient expectations, both of which, it had been assumed, would make it easier to hire them out to private Indian hospitals.

Everything had gone miraculously according to plan, with teams of two nurses currently in six private Indian medical tourism hospitals. For housing, all had been required to live together in a mansion rented by Nurses International in the diplomatic area of New Delhi, to the initial chagrin of the nurses’ families. Since the money the nurses were providing continued, however, family complaints vanished.

After they had been working for a week, with all of them complaining they wanted to go back to California sooner than the six months they were required to remain in India, they had been instructed to begin extracting patient-outcome data from the computers in their respective hospitals. The goal was to be able to begin to calculate infection rates, adverse outcome rates, and death rates for their future ad campaigns. To Cal and the others’ surprise, none of the nurses questioned this activity, and they were wonderfully successful. But then disaster had struck. Something had happened that no one had anticipated. The stats had turned out to be quite good, even strikingly excellent in several of the institutions.

For a few days Cal and Petra had been depressed and unsure of what to do. After all the money they’d gone through to set up the elaborate spy system, they had begun to feel pressure for results. Raymond Housman had even sent a secret representative a week earlier for an update on when they could expect something to happen. It seemed that the bottom-line losses from medical tourism were continuing, and ticking upward at an alarming rate. Cal had promised results would soon be forthcoming, since at the time of the envoy’s visit, the outcome data were just beginning to flow in.

But then, by tapping into his creativity and urge to win, Cal had come up with a second idea. If there were no bad statistics to be found for the basis of a negative ad campaign, why not create their own bad-outcome, hard-luck stories with the help of their installed fifth column and feed the stories to the media in real time. With the unsuspecting help of an anesthesiologist and pathologist whom he’d gotten to know in Charlotte, North Carolina, while he’d worked at SuperiorCare’s corporate office, Cal had settled on succinylcholine as his drug of choice to cause sudden death. The idea was to find patients who’d had a history of some sort of heart disease and who’d had succinylcholine as part of their anesthesia, and inject them with an additional bolus of the muscle-paralyzing drug the evening following their operations. Cal had been assured the drug would be undetectable, and if it was detected, it would be assumed to be from the patient’s anesthesia. Best of all, there’d be an immediate diagnosis of a fatal heart attack because of the cardiac history.

As soon as Cal and Petra had polished the scheme, they presented it to Durell and Santana. Although Durell had taken the plan in stride, Santana had initially been hesitant. For her, stealing privileged data was one thing, but killing people was something else entirely. Still, she had eventually given in, partly as a function of the others’ enthusiasm; partly because of everyone’s commitment to success, including her own; partly because she’d become convinced the scheme could not be discovered; and partly because there was going to be a limited number of victims; but mostly because she and the others believed it to be the only way to salvage Nurses International, which, as it turned out, they were all counting on to be a key step in their careers and in obtaining the wealth they thought they deserved. A lesser reason for her change of heart was the intense study of Hinduism she’d undertaken since she’d arrived in the country. She’d found herself attracted intellectually to the concept of punarjamma, or the Hindu belief in rebirth, meaning death was not the end but merely the door to a new life, and a better one if the individual had adhered to his dharmic responsibilities. And finally was the fact that she, along with the others, had vowed to do whatever it took to denigrate medical tourism.

Once the new strategy had been accepted, the problem had then switched to the nurses’ reactions and the question of their cooperation. Although the group had become so acculturated to American culture from their month in Los Angeles, so addicted to the money they were being paid for the benefit of their families, and were so looking forward to emigrating that they would most likely do whatever was asked of them, Cal, Petra, and Durell were unsure. Santana, on the other hand, thought the nurses would have no problem, as they would be aided by their belief in samsara and particularly their belief in the importance of the organization and the group over the individual. Santana had then said the key was Veena and getting her to accept that it was her dharma to “put to sleep” an American patient. The idea was that if she was willing to do it, as the de facto leader, the rest would unquestioningly follow suit.

But Veena’s cooperation was not a given. While everyone agreed she was the most committed to the team and the most desirous of emigrating, everyone had sensed a disconnect of her obvious keen intelligence, her inborn leadership ability, and her exceptional beauty, with her equally apparent poor self-image and lack of self-esteem. With such a thought in mind, Santana had gone on to explain it was her professional opinion that Veena was burdened with serious psychological baggage of some sort on top of a strongly ingrained attachment to traditional Indian culture and religiosity. She also had suggested that learning the issue and offering to help her with it, whatever it was, might be key in obtaining Veena’s cooperation.